超氧化物歧化酶基因多态性与慢性阻塞性肺疾病的关系

目的 探讨超氧化物歧化酶(superoxide dismutase,SOD)基因多态性与慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)的关系,进一步揭示COPD的遗传易感因素、发病机制.方法 联合应用聚合酶链式反应(PCR)与连接酶检测反应(LDR)测序分型技术检测80例COPD患者(COPD组)、80例长期吸烟而肺功能正常人群(长期吸烟组)和40例无吸烟史的健康人群(对照组)的SOD1-3基因多态性情况,并通过酶联免疫吸附试验(ELISA)检测血清中SOD3浓度.结果 入选对象中检测到SOD1的AA和AC基因型、SOD2的TT、TC和CC基因型以及SOD3的CC和CG基因型.AA和AC基因型在COPD组、长期吸烟组和对照组间的分布频率分别为91.3％、92.5％、90.0％与8.7％、7.5％、10.0％,差异无统计学意义(P＞0.05.TT、TC和CC基因型在相应3组间的分布频率分别为67.5％、65.0％、57.5％,21.3％、25.0％ 、30.0％和11.2％、10.0％、12.5％,差异无统计学意义(P＞0.05).CC和CG基因型在此3组间的分布频率分别为97.5％、87.5％、97.5％和2.5％、12.5％、2.5％,其中CG基因型在长期吸烟组出现的频率高于其他2组,差异有统计学意义(P＜0.05).携带SOD3CG基因型人群血清SOD3浓度为(252.1±46.6) U/ml,未携带者血清SOD3浓度为(45.5±23.2) U/ml,两者差异均有统计学意义(P＜0.05).结论 SOD3基因多态性(C+760G,Arg213Gly)与COPD的易感性有关.     

Health surveillance for occupational chronic obstructive pulmonary disease

Screening for lung disease in workers with a low prevalence of chronic obstructive pulmonary disease (COPD) is subject to debate. Examining all workers would lead to unacceptable costs. Surveillance of high-risk groups may be a useful alternative. Data from 314 workers exposed to dust were used to develop a prediction model. Data from a study comprising 96 rubber workers were used to validate the model's performance. COPD was defined as a ratio of forced expiratory volume in 1 second to forced vital capacity outside the 5th percentile. The accuracy of the model was evaluated by receiver operating characteristic curve analysis and by comparison of the observed versus predicted probabilities. Shortness of breath, wheeze, heavy smoking, and work-related lower respiratory symptoms were identified as independent determinants of having COPD. Workers with COPD can be distinguished from those without COPD on the basis of a medical/work-related questionnaire. Occupational physicians can develop a low-cost strategy for detecting workers at risk for COPD.     

Risk factors of chronic obstructive pulmonary disease

Many personal and environmental risk factors are associated to increased prevalence and severity of chronic obstructive pulmonary disease (COPD). In this review, we shortly describe most of these risk factors, aiming at defining each factor as causative or modifier of the natural history of the disease. It is clear that the environmental risk factors do have an outstanding relevance for both the initiation and the evolution of COPD. This review focuses on the crucial importance of prevention in order to decrease the public health burden of COPD in the western countries during the next decades.     

慢性阻塞性肺疾病患病及相关危险因素研究进展

慢性阻塞性肺疾病（COPD）是一种常见的、可预防和治疗的慢性气道疾病,其特征是持续存在的气流受限和相应的呼吸系统症状。COPD是全球慢性疾病发病率和死亡率的主要原因,是世界三大死因之一,且全球COPD患病率整体呈现上升趋势。我国各省份间COPD患病率一直处于较高水平。COPD的患病率在不同国家、不同地区和不同人群之间均存在差异,并受多种危险因素影响。个体方面的遗传因素、年龄、性别、BMI、腹部肥胖和身体活动会对COPD的发生和发展产生影响;环境方面,吸烟、室内和室外空气污染以及职业中的暴露均会导致COPD的发生。     

慢性阻塞性肺病与胃食道反流的相关性研究

目的　通过抗反流治疗探讨慢性阻塞性肺病 (COPD)与胃食道反流 (GER)的相关性。方法　对 6 4例临床确诊COPD患者及 30例健康者进行消化道症状 (反酸、反食、烧心、咽部异物感和腹胀等 1 8种症状 )发病情况问卷调查 ,以总分≥ 6分为症状性GER的诊断标准。当至少符合以下其中之一时 ,异常GER诊断成立。 (1 ) 2 4h食道pH监测远端电极Demeester总积分≥ 1 4 .72分。 (2 )远端电极Demeester总积分虽小于 1 4 .72分 ,但食道上、下电极至少有 1个咳喘症状相关概率 (SAP)大于 75 %。 (3)酸反流试验阳性。胃肠钡餐透视作为辅助诊断。GER诊断确立后以多潘立酮和麦滋林抗反流治疗 6周。结果　 (1 )治疗前 6 4例COPD患者中有 5 2例GER ,4 8例为异常GER ;健康组GER只有 8例 ,两组GER有显著性差异 (P <0 .0 1 )。对 4 8例异常GER抗反流治疗后发现各项观察指标均有明显改善。 (2 ) 1 1例轻型COPD患者咳嗽气促症状完全消失 ;9例中度COPD患者症状有明显减轻 ,SAP >90 %;2 0例患者临床症状完全控制。 (3)酸反流阳性试验全部阴转 ,肺功能检查发现治疗前后有显著性差异 ,P <0 .0 1。结论　对症状性GER的抗反流治疗 ,可以有效减轻部分COPD患者长期咳嗽气促症状 ,证实了COPD与GER之间的密切相关性。     

老年人慢性阻塞性肺病影响因素分析

慢性阻塞性肺病（COPD）是一种全球性患病率和死亡率较高的重要疾病。近年来,随着城市环境污染与人口的老龄化,COPD的发病率逐年增加,它已成为一种严重影响患者劳动能力与生活质量的慢性呼吸系统疾病。     

Risk factors in chronic obstructive pulmonary disease (COPD).

In a genetic-epidemiologic study of chronic obstructive pulmonary disease (COPD) observations adjusted for age, sex, race, and smoking indicate certain factors to be associated with increased pulmonary function aberrancy, and suggest that they are risk factors for COPD. These presumptive "risk factors" include not only cigarette smoking, but also alpha1-antitrypsin (Pi system) variation, one or more other familial components, low socioeconomic status (SES), and, in whites, ABO blood type (either absence of "B" or presence of "A").     

易误诊为多发性肌炎的肌营养不良临床及病理分析

目的明确肢带型肌营养不良2B（LGMD2B）与多发性肌炎（PM）的鉴别诊断。方法分析LGMD2B临床表现、骨骼肌病理学特点及与PM的关系。结果LGMD2B临床表现为四肢近端肌无力，血清肌酸激酶显著增高，肌电图呈肌源性损害，与PM相似。组织化学染色：呈不同程度肌纤维变性、坏死、再生和炎性细胞浸润，与PM相似。免疫组织化学染色：抗-Dysferlin单克隆抗体染色，5例LGMD2B患者Dysferlin蛋白在肌膜上完全缺失，PM均表达正常。结论LGMD2B临床表现、骨骼肌病理学特点与PM相似，抗-Dysferlin单克隆抗体免疫组织化学染色是鉴别二者的关键。     

老年慢性阻塞性肺疾病患者生活质量与相关因素分析

目的 探讨老年慢性阻塞性肺疾病(COPD)稳定期患者生活质量及其相关因素的影响.方法 选择门诊就诊的60岁以上老年COPD稳定期患者86例,填写生活质量评分表、测定身高体重、进行6 min步行距离、血清T细胞亚群及肺功能的测定;分别对生活质量与年龄、体重指数、6min步行距离及肺功能,肺功能与体重指数,吸烟指数与T细胞亚群进行相关性检验.结果 生活质量总分数与年龄呈正相关(P＜0.05),与体重指数呈负相关(P＜0.01).生活质量总分数与6min步行距离以及第1s用力呼气量呈负相关(P＜0.01).第1s用力呼气量与体重指数呈正相关(P＜0.01).吸烟指数与CD8呈正相关(P＜0.05),与CD4/CD8呈负相关(P＜0.05).结论 生活质量评分表可以简便、快捷评估COPD患者的生活质量状况,具有可行性.吸烟指数可能长期影响COPD患者的T细胞亚群.     

老年慢性阻塞性肺疾病患者生活质量与相关因素分析

目的探讨老年慢性阻塞性肺疾病(COPD)稳定期患者生活质量及其相关因素的影响。方法选择门诊就诊的60岁以上老年COPD稳定期患者86例,填写生活质量评分表、测定身高体重、进行6min步行距离、血清T细胞亚群及肺功能的测定;分别对生活质量与年龄、体重指数、6min步行距离及肺功能,肺功能与体重指数,吸烟指数与T细胞亚群进行相关性检验。结果生活质量总分数与年龄呈正相关(P<0.05),与体重指数呈负相关(P<0.01)。生活质量总分数与6min步行距离以及第1s用力呼气量呈负相关(P<0.01)。第1s用力呼气量与体重指数呈正相关(P<0.01)。吸烟指数与CD8呈正相关(P<0.05),与CD4/CD8呈负相关(P<0.05)。结论生活质量评分表可以简便、快捷评估COPD患者的生活质量状况,具有可行性。吸烟指数可能长期影响COPD患者的T细胞亚群。     

Predicting outcomes from 6-minute walk distance in chronic obstructive pulmonary disease

BackgroundExercise tolerance is an important clinical aspect of chronic obstructive pulmonary disease that can be easily and reliably measured with the 6-minute walking test (6MWT). To improve the utility of the 6MWT for patient and health care system management, the interpretation of the functional status measure in relation to death and hospitalization should be elucidated.MethodsThree-year, prospective, multicenter observational study to evaluate the predictive power of 6MWD for death or exacerbation-related hospitalization and to evaluate the factors that help determine 6MWD.ResultsWe measured 6MWD at baseline and annually in 2110 patients with clinically stable Global Initiative for Obstructive Lung Disease (GOLD) stage II–IV COPD and recorded exacerbation-related hospitalizations and all-cause mortality. During the study, 200 patients died and 650 were hospitalized. Using receiver operating characteristics, the best predictive thresholds of the 6MWD were 334 m for increased risk of death and 357 m for exacerbation-related hospitalization (area under the curve 0.67 and 0.60 respectively); however, the discriminatory thresholds, especially for mortality, were influenced by age. The mean (SE) 6MWD declined by 1.6 (1.2) m per year in GOLD II, 9.8 (1.3) m per year in GOLD III, and 8.5 (2.4) m per year in GOLD IV.ConclusionThe 6MWD provides prognostic information that may be useful for identifying high-risk patients with COPD.     

慢性阻塞性肺疾病患者肺部真菌感染危险因素研究

目的探讨慢性阻塞性肺疾病(COPD)患者继发医院肺部真菌感染及其危险因素,为临床治疗提供可靠的依据。方法回顾性分析2009年1月-2012年6月725例COPD患者的临床资料,对真菌感染患者危险因素进行分析;采用SPSS19.0软件对资料进行统计分析。结果 725例COPD患者中有56例发生肺部真菌感染感染率7.7%,共检出真菌83株,检出白色假丝酵母菌、热带假丝酵母菌、光滑假丝酵母菌、克柔假丝酵母菌、近平滑假丝酵母菌、毛霉菌属、曲霉菌属、葡萄牙假丝酵母菌,分别占60.24%、13.25%、6.02%、4.82%、7.23%、3.61%、2.41%、1.21%;真菌对制菌霉素、两性霉素B、伊曲康唑较敏感,对氟胞嘧啶、酮康唑及咪康唑的敏感性较差;低白蛋白血症、使用肾上腺糖皮质激素>500mg、广谱抗菌药物使用时间>14d、合并呼吸衰竭是COPD患者发生肺部真菌感染的独立危险因素(P<0.05)。结论提高对COPD患者继发肺部真菌感染危险因素的认识,有针对性地采取防治措施,可以减少肺部真菌感染的发生。     

老年慢性阻塞性肺疾病患者肺部感染的危险因素分析

目的研究老年慢性阻塞性肺疾病(COPD)患者发生肺部感染的危险因素,为其防治提供可靠的依据。方法回顾性分析2011年12月-2012年12月住院的老年COPD患者80例,发生肺部感染30例,调查肺部感染的相关危险因素,进行多因素logistic回归分析;通过SPSSl5.0软件对数据进行统计分析。结果感染患者年龄≥60岁占83.3%、有吸烟史占33.3%、滥用抗菌药物占70.0%、侵入性操作占73.3%、并发高血压占70.0%、糖尿病占63.3%,其他呼吸系统疾病占66.7%;而多因素分析结果显示,年龄≥60岁、基础疾病、滥用抗菌药物以及住院时间的延长均导致住院老年COPD患者肺部感染发生,是其发生的独立危险因素(P<0.05)。结论住院老年COPD患者发生肺部感染同年龄≥60岁、基础疾病、滥用抗菌药物以及住院时间等因素相关。     

Consequences of chronic obstructive pulmonary disease and chronic heart failure: the relationship between objective and subjective health

This study investigates whether the relationship between objective health parameters and general health perceptions was mediated by symptoms of dyspnoea and physical functioning in patients with chronic obstructive pulmonary disease (COPD) and patients with chronic heart failure (CHF). The different health parameters were organised according to Wilson and Cleary's conceptual model of patient outcomes (Wilson & Cleary (1995). Journal of the American Medical Association, 273, 59-65). Second, we investigated whether perceptions of personal control were related to the health parameters in the model. Consecutive patients with COPD and CHF were included from the outpatient clinics of a university hospital and a general hospital, and from a rehabilitation centre, all in the Netherlands. Ninety-five COPD patients (aged 65.0+/-9.3; forced expiratory volume in 1s (FEV1)<70%) were included and compared with 90 CHF patients (aged 59.6+/-10.0; left ventricular ejection fraction (LVEF)<45%). The relationship between objective health parameters (FEV1 or LVEF) and subjective health (self-reported physical functioning) was not mediated by symptoms of dyspnoea. FEV1 or LVEF and symptoms of dyspnoea were independently related to self-reported physical functioning, which was directly related to general health perceptions. Perceived health competence was related to symptoms of dyspnoea and general health perceptions in patients with either COPD or CHF. Although patients with COPD reported lower levels in all self-reported health parameters in the model than the patients with CHF, this study showed that the relations between the health parameters in the model were comparable for COPD and CHF patients.     

Relationship between Helicobacter pylori infection and chronic obstructive pulmonary disease

There is some evidence indicating the role of Helicobacter pylori infection in pathogenesis of extragastrointestinal diseases including skin, vascular, and autoimmune disorders, as well as some respiratory diseases. The aim of this study was to investigate the association between H. pylori and chronic obstructive pulmonary disease (COPD). In a case-control study, 90 patients with COPD and 90 age- and sex- matched control subjects were included. Serum samples were tested for anti-H. pylori and anti-CagA IgG by ELISA. A physician completed a questionnaire including demographic characteristics, habitual history, and spirometric findings for each patient. Of 90 patients with COPD 66 (51%) had mild, 31 (34.4%) moderate, and 13 (14.4%) sever disease. There was no significant association between H. pylori IgG seropositivity and COPD. Serum levels of anti-CagA IgG were significantly higher in patients with COPD than in the control subjects (P < 0.001). No association was observed between H. pylori infection and severity of COPD. The results suggest that there is an association between CagA-positive H. pylori infections and COPD. Further studies should be planned to investigate the potential pathogenic mechanisms that might underlie these associations.     

福州市慢性阻塞性肺疾病的检出率及相关因素

目的掌握福州市慢性阻塞性肺疾病(COPD)的患病情况和影响因素,为基层开展COPD健康教育提供基础数据。方法以整群随机抽样方法抽取福州市台江区3个街道6个居委会2 400户居民户,每户用KISH表法随机抽取40岁及以上居民1名,对随机抽取2 156人进行面对面问卷调查、体检和肺功能检查,对FEV1/FVC<70%人群进行心电图和胸片检查。结果福州市40岁及以上人群COPD总检出率为6.33%,男性检出率明显高于女性(P<0.01)。随着年龄增长、受教育程度越低、有父亲或母亲家族史、经常接触粉尘或有害气体、经常接触油烟其检出率上升(P<0.01/0.05);而工作中采取防护器具、在室外做饭人群COPD检出率低(P<0.01)。多因素分析,男性、年龄≥50岁、有父或母家族史、吸烟和被动吸烟、经常接触油烟与COPD发生呈正相关;受教育程度与COPD发生呈负相关。结论福州市COPD检出率低于全国平均水平,年龄、吸烟等人口学特征及油烟接触是COPD发病的重要相关因素。     

Risk factors for chronic obstructive pulmonary disease mortality in Chinese adults

Chronic obstructive pulmonary disease mortality and risk factors were studied in a nationally representative sample of 169,871 Chinese men and women aged 40 years or older. Baseline data were collected in 1991 by using a standard protocol, and a follow-up evaluation was conducted in 1999-2000, with a response rate of 93.4%. Age-standardized mortality (per 100,000 person-years) was 179.9 for men and 141.3 for women. After adjustment for important covariables, the respective relative risks of chronic obstructive pulmonary disease-related mortality for baseline risk factors in men and women were 2.80 (95% confidence interval (CI): 2.64, 2.98) and 2.71 (95% CI: 2.53, 2.89) for each 10-year increase in age, 0.84 (95% CI: 0.74, 0.95) and 1.44 (95% CI: 1.07, 1.95) for alcohol consumption, 1.18 (95% CI: 1.04, 1.35) and 1.77 (95% CI: 1.45, 2.15) for >/=20 pack-years of smoking, 2.37 (95% CI: 1.91, 2.94) and 2.47 (95% CI: 1.66, 3.67) for non-high-school graduation, 1.57 (95% CI: 1.38, 1.79) and 1.35 (95% CI: 1.17, 1.56) for physical inactivity, 2.66 (95% CI: 2.34, 3.02) and 2.60 (95% CI: 2.25, 3.00) for underweight, 1.39 (95% CI: 1.23, 1.57) and 1.73 (95% CI: 1.50, 2.00) for living in northern China, and 2.14 (95% CI: 1.86, 2.46) and 1.79 (95% CI: 1.55, 2.07) for living in rural China. This study indicated that cigarette smoking, low educational level, physical inactivity, and underweight are important modifiable risk factors for chronic obstructive pulmonary disease-related mortality in China.     

慢性阻塞性肺疾病急性加重患者的预后影响因素

目的 探讨慢性阻塞性肺疾病急性加重（AECOPD）患者的预后影响因素.方法 以本院352例AECOPD住院患者为研究对象,采用多因素Logistic回归和多因素Cox比例风险回归筛选住院死亡和一年生存时间的影响因素.结果 多因素Logistic回归示PaO2（OR=0.082）、肌酸磷酸激酶同工酶（CKMB,OR =4.967）、机械通气（OR=6.903）、白蛋白（ALB,OR=0.221）、FEV1占预计值％（OR=0.255）、charlson指数（OR=8.406）和住院天数（OR=0.075）与住院死亡有关（均P＜0.05）.多因素Cox风险回归示SaO2（ HR=0.224）、肌钙蛋白Ⅰ（cTnI,HR=3.824）、ALB（ HR=0.569）、FEV1占预计值％（HR =0.494）、charlson指数（HR =4.319）、住院天数（HR=0.456）和急性加重频率（HR=1.611）与一年生存时间有关（均P＜0.05）.呼吸困难指数（MRC）与急性加重频率正相关（rs =0.508,P＜0.01）.结论 PaO2、ALB、FEV1占预计值％降低,CKMB和charlson指数升高,AECOPD患者住院死亡风险增高.SaO2、ALB、FEV1占预计值％降低,cTnI阳性,charlson指数和急性加重频率增高,患者一年生存风险增高.急性加重频率越高,患者呼吸困难越严重,生存质量越差.     

中国成年人慢性阻塞性肺疾病与骨密度的相关性分析

目的 探究我国成年男性和女性中慢性阻塞性肺疾病（COPD）与骨密度的关系。方法 利用中国慢性病前瞻性研究第二次重复调查的数据,采用线性回归分析COPD及慢性阻塞性肺疾病全球倡议（GOLD）分级与跟骨骨密度指标（宽带超声衰减、超声声速、强度指数）之间的相关性。结果 共纳入23 876名研究对象,男性COPD患病率为34.3%（3 130/9 125）,女性COPD患病率为23.2%（3 416/14 751）。以健康男、女性为参照,男、女性COPD患者的宽带超声衰减、超声声速、强度指数均降低,男性对应的β值（95%CI）分别为-0.87（-1.37~-0.36）、-3.42（-5.42~-1.43）、-1.53（-2.34~-0.71）,女性对应的β值（95%CI）分别为-0.66（-1.09~-0.23）、-2.24（-3.92~-0.55）、-1.06（-1.71~-0.40）,男性中下降幅度更大（交互作用均P<0.05）。GOLD分级与宽带超声衰减、超声声速、强度指数呈负相关,且存在线性趋势（线性趋势检验均P<0.001）。亚组分析显示,男性年龄≥60岁、男性低体力活动水平者、男、女性非超重/肥胖者中COPD患者骨密度下降幅度更大。结论 COPD与骨密度呈负相关,应加强对COPD患者骨密度的关注,尤其应关注年龄大、体力活动水平低、非超重/肥胖的COPD患者。